S147 On-Site ERCP Availability Does Not Impact Cholangitis Outcomes: A Retrospective Cohort Study
Bibliographic record
Abstract
Introduction: ERCP is a key component acute cholangitis (AC) management but is not available at all hospitals. The impact of on-site ERCP availability on cholangitis outcomes unknown. Methods: In this cohort study, we included adults diagnosed with acute cholangitis at 27 hospitals in Ontario through the GEMINI collaborative. We collected data on demographics, clinical and laboratory values, and interventions. The primary outcome was in-hospital mortality. Secondary outcomes were length of stay, intensive care unit (ICU) admission, readmission rates, and requirement for percutaneous or surgical decompression. We used multivariable regression analyses to assess the impact of on-site ERCP availability on the primary and secondary outcomes, adjusting for demographics, comorbidities, severity of initial disease, and underlying hepatopancreaticobiliary (HPB) malignancy. We performed subgroup analyses on patients with HPB malignancy and severe cholangitis (Figure 1). Results: There were 4943 patients in our cohort (3942 at ERCP site, 1001 at non-ERCP site). The median age was 74, 15% had underlying HPB malignancy, and 19% had severe cholangitis. In hospital mortality was 4%. On-site ERCP availability did not impact in-hospital mortality (odds ratio (OR)=1.08,95%CI=0.73-1.59) or any secondary outcomes. In the subgroup analysis, severe AC patients at ERCP-sites had lower odds of ICU admission (OR=0.36,95% CI=0.14-0.94) and 7-day readmission (OR=0.46,95%CI=0.23-0.92) (Table 1). Conclusion: On-site ERCP availability did not impact in-hospital mortality. For patients with severe cholangitis, on-site ERCP availability was associated with lower odds of ICU admission and 7-day readmission. While these results should be interpreted cautiously, patients with severe AC may warrant early consultation with a hepatobiliary endoscopist.Figure 1.: (A) percentage of patients with cholangitis at ERCP and non-ERCP centers who underwent ERCP during the hospitalization. (B) Among patients who underwent ERCP, percentage who underwent ERCP in <24h, between 24-48h, and >48h after admission. Table 1. - Unadjusted Estimates and Adjusted Effects Comparing ERCP-Sites to Non-ERCP Sites for Primary and Secondary Outcomes Outcome Unadjusted estimates Adjusted effect In-hospital mortality 4% (ERCP site) vs 5% (non-ERCP site) OR 1.08 (95% CI 0.73-1.59) Length of stay 5.25 days vs 5.90 days RR 0.93 (95% CI 0.83-1.05) 7-day readmission 5% vs 3% OR 0.74 (95% CI 0.54-1.06) 30-day readmission 13% vs 11% OR 0.88 (95% CI 0.69–1.13) ICU admission 11% vs 13% OR 0.68 (95% CI 0.29-1.64) Percutaneous intervention 8% vs 5% OR 1.30 (95% CI 0.57-2.93) ICU – intensive care unit; ERCP – endoscopic retrograde cholangiopancreatography; OR – odds ratio; CI – confidence interval; RR – risk ratio.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".